Movement Disorders

By Dr. A. R. Scopelliti

Apr

19

Over 40 million Americans – 1 in every 7- suffer with a movement disorder.  That’s more than double the number of people who suffer with diabetes, which, is in itself a staggering number.  A person who has a movement disorder will typically see on average 15 different doctors, over the course of 5 years before one of them actually recognizes and properly identifies the problem.  To those individuals suffering with movement disorders this is a very real problem and as such those suffering are very much underserved.  Making matters worse, movement disorders, once recognized, are typically treated by drugs which were not necessarily developed for the treatment of any particular movement disorders.  And if this is not bad enough, most of these drugs are actually known to cause movement disorders, such as tremors.  Surprisingly, one can develop these tremor side affects, (called tardive dyskinesias), from a single dose of prescribed medication.  Most people think that you have to take a lot of a drug before it will inflict side affects, though in actuality, this is clearly not the case.   So is there a better approach to this?  Well, actually in a word, yes.  As a functional neurologist, I routinely spend my day seeing patients with movement disorders, most of whom have been referred to me to ascertain what is going on with them what is causing them to move the way they do.  Many of these movement disorders can actually be treated better without drugs using neurologic rehabilitation, whereby we restructure the brains neurologic connections using simple exercises and activities, affording the brain appropriate integration of the many neuronal pools which all have to work synergistically together at all times.  The trick to this is that the diagnosis needs to be extraordinarily precise, as no two patients, even with the same movement parameters, are typically going to be managed the same. Because of the simplicity of this approach as well as the lack of harmful side affects, there is little sense in utilizing alternative drug therapies in favor of appropriate neurologic rehabilitation.  Another problem with the drug approach lies in the fact that since the drugs are not treating anything at all and at best hoping to ameliorate some symptoms, the underlying cause continues to worsen.  Often times as this goes on for a long time, the movement disorder becomes difficult or even impossible to entirely correct due to the vast reorganizational changes that have now occurred in the brains many interconnections.  This is particularly frustrating for me as a clinician as well as for a patient suffering with a movement disorder as had they presented years earlier the problem would have been much easier to treat successfully.

Vestibular Rehabilitation Therapy

By Dr. A. R. Scopelliti

Oct

6

So what is vestibular rehabilitation therapy, a.k.a.VRT?  Think about it like this.  Suppose you just had shoulder surgery.  Would you be all better, or would you now need to do physical therapy to rehabilitate your shoulder back to normal function?  Without rehab such as this, I can tell you that you will never regain normal use of your shoulder.  Well the same is rue of the vestibular labyrinth.  Whenever you have any affliction that causes any type of dizziness or vertigo, without vestibular rehabilitation therapy exercises, it is highly unlikely that you will just return to normal function.

Is There a Difference Between Physical Therapy and Vestibular Rehabilitation Therapy?

Yes.  Physical therapy involves exercise therapy primarily for the trunk and limbs.  This can oftentimes be useful for individuals with increased fall risk and imbalance.   However, it should not be confused with vestibular rehabilitation therapy which concerns itself with rehabilitation of the vestibular labyrinth, brain and oculomotor system.

How Does Vestibular Rehabilitation Therapy Work?

Just like physical therapy makes muscles grow stronger and more coordinated, vestibular rehabilitation therapy is a method of habituating neurons of the central nervous system, (primarily the brain), and the vestibular system so that neurologic function  may be enhanced thus improving the function of the balance systems. Because neurons respond and grow very differently than does muscle tissue however, vestibular rehabilitation therapy must be done very specific to your needs.  This is to say that a canned approach will not work.  Two individuals with the same exact problem may respond very differently to vestibular rehabilitation therapy depending on the extent of involvement of their disorder, their overall health going into treatment, and their level of stamina in their ability to perform the exercises in the first place. If this is not taken into consideration in the therapy plan, the treatment is destined to fail and will in all likelihood even worsen the patients status.  I see this all of the time in my own practice as it is a common occurrence and reason for referral to my office in the first place.

“Mystery Disorders”

By Dr. A. R. Scopelliti

Jun

28

So why is it that one can go to ten different specialists, get no diagnosis or effective treatment , and that same individual can then come to see me and get better in a few days?  Am I just very lucky?  Is it the power of suggestion?  Well, I can tell you, that’s not it.

Here is why.  Most specialists do what they do very well.  They excel in and have vast studies preparing for their particular area of expertise.  However, most human suffering is not always textbook.  That is to say that when a doctor studies disorders, they do not always match up with what we might see in our offices.  Further, most doctors tend to be trained such that they are examining you with a goal of matching up your symptoms with illnesses that are referenceable in a medical textbook.  Many disorders can be diagnosed in this manner; however, the vast majority of human suffering is not from these “named” diseases.  It is from “shades of grey” symptoms that do not typically match up well with any disorder, yet are real symptoms for the patient.  Since the doctor cannot find any disease that matches your conditions symptoms, you are simply told to “learn to live with it”, or worse, “it’s all in your head.”  Few doctors examine patients cumulatively just trying to get a grasp of what might be realistically happening with that person rather than just trying to find the matching diagnosis code to send to the insurance carrier.  Well when you think about this, you can see how easy it is to have no idea of what may be happening to explain your symptoms.  It is easy to see how all of the individuals with disorders that fall into the “shades of grey” area are just going to be brushed off as being odd or unrealistic problems.

The reason why my office has so much success in this area, is because when I examine patients, I do not have a predisposed opinion of what disease I am trying to rule out.  I look at them for what they are, a human being with symptoms, and I use logic to rationalize what neurophysiology is not working properly, and more importantly, what could be done to fix it.  My office has had great success treating patients with difficult disorders in this regard.  Because of our success, we routinely see patients who come from other states and spend a week with me so that they may get better.

So if you have been told to “learn to live with it”, or have been going from doctor to doctor without answers, you are my best patient.  We always offer a complementary consultation if you prefer one prior to examination as we understand that you may have many questions simply out of years of frustration in dealing with the medical system.

Dystonia

By Dr. A. R. Scopelliti

Mar

13

Dystonia is a neurological movement disorder affecting more than 300,000 people in North America alone. It is characterized by involuntary muscle contractions, which force certain parts of the body into abnormal, sometimes painful, movements or postures.  This typically manifests as a no-no tremor, (oscillation of the head side to side, as if nodding no repetitively).  Dystonia can affect any part of the body including the arms and legs, trunk, neck, eyelids, face, or vocal cords.  Because muscle contractions interfere with normal function, dystonia causes impairment such as incoordination and problems with balance, (and thus increased risk of fall).  As such, those afflicted with the disorder often find themselves unable to perform many of the things they did prior to its inception.  Pain and fatigue from the repetitive movement is not uncommon.  Features such as cognition, strength, and the senses, including vision and hearing, are typically normal and left unaffected.  As the disorder becomes intolerable, botox injections are typically used to help control the disorder and excess movement. Botox injections are simply isolated botulism toxins, which paralyze the muscles near the injection site for a period of time.  As the toxin’s effect wears off over time, the procedure must be repeated. Recent research demonstrates the tremendous effect chiropractic neurologists can have on cervical dystonia when managed in accordance with brain based neurology. Results using this approach have been described as outstanding and provide hope for dystonic patients looking for non-surgical and non-drug treatment options.  For this reason, it is recommended that patients who have dystonic movements and associated symptomatology be treated in this fashion before other treatments which may be associated with iatrogenesis, (problems induced inadvertently by a medical treatment), are considered.  At minimum, a fall risk screen should be performed on anyone suffering with this disorder, due to the increase risk of fall associated with the tremor.  Our office offers this service as a community service free of charge.